Yorkshire and the Humber Mental Health Network Welcome and Introductions to the Yorkshire & Humber Liaison Mental Health Network Dr Katie Martin,Clinical Lead, Yorkshire and the Humber Clinical Networks www.england.nhs.uk
Agenda Welcome and Introductions to the Yorkshire & Dr Katie Martin 13.30 Humber Liaison Mental Health Network Clinical Lead Yorkshire and the Humber Clinical Networks IAPT Long Term Conditions Programme and the Fit Ursula James 13.35 with Liaison Mental Health IAPT Programme Manager Group discussion NHS England TEWV Evaluation, Demonstrating the Savings Aimee Fox & Sebastian Hinde, Research Fellows 14.20 Group discussion re. impact on Wave 2 applications University of York Assessment Paperwork – Group session 15.05 Led by Katie Close 15.30 www.england.nhs.uk
Yorkshire and the Humber Mental Health Network The IAPT Long Term Conditions Programme Ursula James IAPT Programme Lead NHS England www.england.nhs.uk
IAPT Programme Expanding IAPT services to deliver successful interventions for long term conditions Integrating IAPT with physical health pathways IAPT-LTC Ursula James – National IAPT Programme Manager www.england.nhs.uk
IAPT programme- general overview • Transformed treatment of anxiety & depression • Stepped care psychological therapy services established in every area of England. Self-referral. • 15.8% of local prevalence (956,000 people) seen in services in 16/17 • Around 69% have course of treatment (over 565,000 per year) • Outcomes recorded in 98% of cases (pre-IAPT 38%) • Very strict (depression & anxiety) recovery criteria • Nationally 51% recover and further 16% improve. • 6 of every 10 CCGs have recovery > 50%, some > 60%. IAPT programme- current standards • At least 50% of people completing treatment should move to recovery. • 16.8% of people with depression and anxiety disorders should access treatment in 17/18 rising to 25% by 2020/21. • 75% of people should start treatment within 6 weeks of referral, and 98% within 18 weeks. • NHS Operational Planning and Commissioning Guidance 2017-19 • CCGs should commission additional IAPT services, in line with the trajectory to meet 25% of local prevalence in 2020/21. • Ensure local workforce planning includes the number of therapists needed and mechanisms are in place to fund trainees. • From 2018/19, commission IAPT services integrated with physical healthcare and supporting people with physical and mental health problems – IAPT-LTC (Long Term Conditions) www.england.nhs.uk 5
FYFV Commitments No acute hospital is without all- 70,000 more children will Intensive home treatment will be age mental health liaison services, available in every part of England as access evidence based mental and at least 50% are meeting the health care interventions an alternative to hospital. ‘core 24’ service standard At least 30,000 more women 10% reduction in suicide and all Increase access to evidence-based each year can access evidence- areas to have multi-agency suicide psychological therapies to reach based specialist perinatal prevention plans in place by 2017 25% of need, helping 600,000 mental health care more people per year 60% people experiencing a first The number of people with SMI 280,000 people with SMI will have who can access evidence based episode of psychosis will access access to evidence based physical Individual Placement and NICE concordant care within 2 health checks and interventions Support (IPS) will have doubled weeks including children New models of care for tertiary There will be the right number of Inappropriate out of area MH will deliver quality care close CAMHS T4 beds in the right place placements (OAPs) will have to home reduced inpatient spend, reducing the number of been eliminated for adult acute increased community provision inappropriate out of area mental health care including for children and young placements for children and people young people www.england.nhs.uk 6
FYFV Commitments: Increase access to 1.5m people a year 2,000 Access 25% 25% 1,800 Number of people accessing treatment, 22% 1,600 20% 19% 1,400 1,370 15.80% 15.58% 1,500 16.80% 1,200 1,160 15% thousands 1,020 1,000 960 953 800 10% 600 Projected access rate 400 5% People accessing treatment (thousands) 200 0% 0 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 NEXT STEPS ON THE NHS FIVE YEAR FORWARD VIEW www.england.nhs.uk 7
What will this mean for CCGs and Providers? • CCGs should commission additional IAPT services, in line with the trajectory to meet 25% of local prevalence in 2020/21. • To meet the increase in access (66%), providers will need an additional increase in staff of at least 50%. • Overall planning of workforce should include increasing the number of trainees to meet 4,500 commitment by 2020/21, this has been disseminated via regional teams with numbers at CCG level. • Overall planning of workforce should include increasing the numbers of therapists co-located in general practice by 3,000 by 2020/21. • From 2018/19 , commission IAPT services integrated with physical healthcare and supporting people with physical and mental health problems – IAPT-LTC www.england.nhs.uk 8
2016/17 and 2017/18 - IAPT Early Implementer Programme Aim : • To implement integrated psychological therapies at scale – improving care and outcomes for people with mental health problems and long term physical health problems, and distressing and persistent medically unexplained symptoms. • To learn how best to implement integrated psychological therapies at scale in an NHS context – moving from trials and pilots to business as usual. • To build the return on investment case for integrated psychological therapies – demonstrating savings in physical health care. • To build capacity in the IAPT workforce, starting the expansion of the workforce needed to meet 600,000 extra people entering treatment by 2020/21. • Challenging the Mind/Body split www.england.nhs.uk
IAPT Wave 1 and 2 CCGs London • 68 CCGs • 62% of all STP’s have at least 1 CCG within commissioning IAPT-LTC Wave 1 Key Wave 2
IAPT-LTC Definition What defines an Integrated IAPT service? What defines an Integrated IAPT service? An integrated service will expand access to psychological therapies for people with long term health conditions or MUS by providing care genuinely integrated into physical An integrated service will expand access to psychological therapies for health pathways working as part of a multidisciplinary people with long term health conditions or MUS by providing care team, with therapists, who have trained in IAPT LTC/MUS genuinely integrated into physical health pathways working as part of a top up training, providing evidence based treatments multidisciplinary team, with therapists, who have trained in IAPT collocated with physical health colleagues. LTC/MUS top up training, providing evidence based treatments collocated with physical health colleagues. It is important to keep this definition in mind when setting up your integrated service. It may be that in the beginning all these requirements are not met however you should be aiming for a service model which satisfies all 3 of the criteria above . www.england.nhs.uk 11
How? • Co-located physical and mental healthcare • NICE-recommended therapies, adapted for people with LTCs and delivered by properly trained therapists. Hence the need for CPD courses for IAPT Hi & PWPs • IT systems support outcome monitoring for all (mental health symptoms, disability, perception of physical health problems). • All IAPT’s existing quality standards. • Closely linked to, and managed with core IAPT (don’t try to reinvent the wheel) www.england.nhs.uk 12
What is available to support implementation? CPD for therapists in psychological therapy for people with long term conditions and/or medically unexplained symptoms Extra core trainees to backfill experienced staff moving into IAPT-LTC Service design: implementation guidance available Suite of guidance including: accessible “how to” guide; Building the business case document; IAPT-LTC data handbook; IAPT-LTC data quality guide; IAPT-LTC FAQ’s www.england.nhs.uk 13
Which LTC’s? Summary of Wave 1 and 2 sites The most common LTCs that are likely to be seen in new integrated IAPT services:- • Diabetes • Chronic obstructive pulmonary disease (COPD) • Cardiovascular disease (CHD) • Musculoskeletal problems, Chronic pain. • MUS Colocation for the Early Implementers:- • GP Practices/Primary Care • Acute Hospitals and Secondary Care • Community Teams www.england.nhs.uk 14
Learning from process so far Commissioners • There is enthusiasm in providers and CCGs to develop integrated services, and there are examples of services that are already providing psychological therapies in this way • Start early! Engagement, relationships and development of pathways does take time • Develop a good implementation plan which is co-produced, has both physical and mental health input along with service user collaboration • When developing pathways, carefully consider local nuance – where lends itself to integrated working? What do the Right Care packs show? • Mapping exercise to prevent duplicate commissioning- what is commissioned from the physical care envelope • Can this work across the STP/ vanguard www.england.nhs.uk 15
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